Potentially modifiable risk factors of acute kidney injury after emergency abdominal surgery

Abstract Background Emergency abdominal surgery has high rates of mortality and morbidity. We aimed to investigate the incidence and prognosis of AKI and find potentially modifiable risk factors for AKI after emergency abdominal surgery. Methods We retrospectively reviewed consecutive patients who underwent emergency open abdominal surgery at a single tertiary care university hospital between 2010 and 2022 ( n = 474). Baseline characteristics, surgery, and anesthesia-related parameters were included in our binary logistic regression analysis. The smooth transformation of linear associations of our covariates with AKI was evaluated using restricted cubic splines. Results The overall incidence of AKI was 20.3% ( n = 96). Postoperative AKI is significantly associated with clinical outcomes including admission to ICU, length of hospital and ICU stay, and in-hospital mortality. Multivariable logistic regression analysis for postoperative AKI revealed that age, body mass index, and ASA classification class 3 or 4 were significant predictors. Furthermore, intraoperative vasopressin continuous infusion (odds ratio 4.06, 95% confidence interval [CI] 1.19–13.9), preoperative platelet count (odds ratio 0.72, 95% CI 0.57–0.90, p = 0.003), and maximal serum lactate level during surgery (and odds ratio 1.14, 95% CI 1.04–1.26, p = 0.006) were identified as potentially modifiable risk factors. Conclusion Risk factors reported in our analysis may help clinicians evaluate the risk of AKI after emergency abdominal surgery. Further prospective clinical trials are required to investigate whether any interventions regarding the significant predictors revealed in our study could mitigate the risk of AKI.